Pre-Implementation Evaluation Screening Form
Screening form to assess if your project is ready to move into implementation. Please complete all sections accurately.
Project Name or ID
*
Requestor Full Name
*
First Name
Last Name
Requestor Email Address
*
example@example.com
Project Type
*
Please Select
New Implementation
Upgrade
Integration
Process Improvement
Other
Target Implementation Timeline
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Readiness Status
*
Ready to Implement
Some Preparation Needed
Significant Preparation Needed
Key Dependencies or Blockers
Required Resources for Implementation
Risk/Impact Rating
*
Please Select
Low
Moderate
High
Preferred Next Step
*
Proceed to Implementation
Schedule Further Review
Address Outstanding Issues
Submit Evaluation
Should be Empty: